MON-794 - Associations between DXA-Derived Body Composition, Bone Mass, and Metabolic Parameters in Individuals with Long-Standing Type 2 Diabetes

Background: Type 2 diabetes (T2D) is associated with increased fracture risk despite normal or elevated bone mineral density (BMD), suggesting impaired bone quality. Chronic hyperglycemia, insulin resistance, and unfavorable body composition may contribute to skeletal fragility.

Objective: To investigate associations between DXA-derived body composition, BMD, and clinical-metabolic variables in individuals with long-standing T2D.

Methods: Cross-sectional study conducted between 2023–2025 at a tertiary outpatient clinic of Santa Casa de Misericórdia de São Paulo, Brazil. Adults with confirmed T2D were consecutively enrolled. All participants provided written informed consent. Clinical, anthropometric, laboratory, and DXA data were collected. Fat Mass Index (FMI) was calculated as fat mass/height². Statistical analyses were performed using GraphPad Prism 10.0. Correlations, group comparisons, and multivariable linear regression were applied.

Results: A total of 137 participants were analyzed (67.1% women; mean age 65.0±7.5 years; diabetes duration 19.0±11.5 years). FMI correlated inversely with diabetes duration (r=–0.432, p=0.0002) and positively with systolic (r=0.442, p=0.0002) and diastolic blood pressure (r=0.395, p=0.001). Femoral neck T-score showed negative correlations with HbA1c at diagnosis (r=–0.774, p< 0.0001), waist circumference (r=–0.448, p=0.0003), total body fat percentage (r=–0.269, p=0.0021), and lower limb fat percentage (r=–0.395, p=0.0006), and a positive correlation with appendicular lean mass (r=0.240, p=0.006). Serum creatinine was not associated with BMD at any skeletal site. Nineteen participants (13.9%) had osteoporosis and showed significantly lower femoral neck and total femur BMD (p < 0.000001), body weight (p=0.017), and fat mass (p=0.028). Multivariable analysis did not identify independent predictors of BMD.

Conclusion: In individuals with long-standing T2D, progressive alterations in body composition are associated with cardiometabolic risk and skeletal health. Glycemic control and regional adiposity significantly influence femoral neck BMD. DXA provides a comprehensive tool for integrated assessment of fracture risk in T2D.

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